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Updated: Jun 9, 2026

Problem-Solving Before Instruction (PS-I): A Protocol for Assessment and Intervention in Students with Different Abilities
Published on: September 11, 2021
Short-form measures of hypoglycemia problem-solving ability: the Hypoglycemia Problem-Solving Scale (HPSS)-5 and
Naoki Sakane1, Masayuki Domichi1, Akiko Suganuma1
1Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan.
Aims/Hypothesis:
This study aimed to develop and validate a brief 5-item version of the Hypoglycemia Problem-Solving Scale (HPSS-5) and a single-item screening tool (HPSS-1) for the rapid assessment of hypoglycemia problem-solving ability in adults with type 1 diabetes.
Methods:
In this post-hoc analysis of the PR-IAH study, data from 233 adults with type 1 diabetes were analyzed to examine reliability and validity. Internal consistency, construct validity, and discriminative performance were evaluated using confirmatory factor analysis (CFA) with a robust estimator and receiver operating characteristic (ROC) analysis.
Results:
Participants with high and low hypoglycemia problem-solving ability accounted for 17.2% and 27.5% of the sample, respectively. CFA of the five selected items demonstrated excellent model fit (χ2(5) = 3.74, p = 0.588; CFI = 1.000; TLI = 1.001; RMSEA = 0.000; SRMR = 0.021). The HPSS-5 showed good internal consistency (ω = 0.80). ROC analysis indicated high discriminative accuracy, with areas under the curve (AUCs) of 0.969 (95% CI 0.949-0.989) and 0.986 (95% CI 0.976-0.997) for identifying high and low problem-solving abilities, respectively. The single-item screener (HPSS-1; "When my attempt to prevent hypoglycemia fails, I will analyze and identify my mistake") also showed good performance, with AUCs of 0.885 (95% CI 0.836-0.935) and 0.872 (95% CI 0.828-0.915), respectively.
Conclusions/Interpretation:
The HPSS-5 and HPSS-1 are psychometrically robust, time-efficient instruments for evaluating hypoglycemia problem-solving ability, suitable for use in both clinical practice and research.
Trial Registration:
University hospital Medical Information Network (UMIN) Center: UMIN000039475), Approval date 13 February 2020.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s13340-026-00911-8.
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